The Effect of Contralateral Carotid Occlusion in Patients Undergoing Carotid Artery Endarterectomy

Authors

  • Luis Duarte-Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
  • António Pereira-Neves Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine – Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
  • Filipa Jácome Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal;
  • Diogo Domingues-Monteiro Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal;
  • João P. Rocha-Neves Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine – Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal

DOI:

https://doi.org/10.48750/acv.419

Keywords:

Carotid arterial disease, Carotid endarterectomy

Abstract

INTRODUCTION: Contralateral carotid occlusion (CCO) is considered a high-risk condition for patients undergoing carotid artery endarterectomy (CEA). Patients with a CCO may be intolerant to carotid cross-clamping during CEA, thus prone to postoperative adverse neurological outcomes. Patients with CCO may also have a higher burden of atherosclerotic disease, leading to a higher rate of cardiovascular events.

METHODS: A Medline search was performed in order to identify publications focused on the impact of CCO on outcomes after CEA.

RESULTS: Patients with CCO present a higher incidence of intolerance to carotid cross-clamping. The rates of shunt use are higher in patients with CCO. In the postoperative period, patients with CCO show a higher rate of stroke. Evidence regarding the effect of CCO on long-term outcomes remains controversial, with most studies reporting a lack of association between CCO and adverse long-term outcomes after CEA.

CONCLUSION: Patients with CCO have an increased risk of postoperative adverse outcomes. The best strategy for this group of patients should be based on a case-by-case approach.

Downloads

Download data is not yet available.

References

Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, et al. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(1):3-81.

Grobben RB, Vrijenhoek JE, Nathoe HM, Den Ruijter HM, van Waes JA, Peelen LM, et al. Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endarterectomy. Eur J Vasc Endovasc Surg. 2016;51(4):473-80.

Vilarino-Rico J, Pita-Fernandez S, Segura-Iglesias RJ. Clinical predictors of major adverse cardiovascular events during long-term follow-up after carotid endarterectomy. Ann Vasc Surg. 2015;29(3):419-25.

Giannopoulos A, Kakkos S, Abbott A, Naylor AR, Richards T, Mikhailidis DP, et al. Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy. Eur J Vasc Endovasc Surg. 2015;50(5):573-82.

Petty GW, Brown RD, Jr., Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30(12):2513-6.

Touze E, Trinquart L, Felgueiras R, Rerkasem K, Bonati LH, Meliksetyan G, et al. A clinical rule (sex, contralateral occlusion, age, and restenosis) to select patients for stenting versus carotid endarterectomy: systematic review of observational studies with validation in randomized trials. Stroke. 2013;44(12):3394-400.

Nicholls SC, Kohler TR, Bergelin RO, Primozich JF, Lawrence RL, Strandness DE, Jr. Carotid artery occlusion: natural history. J Vasc Surg. 1986;4(5):479-85.

Goldstein LB. Extracranial carotid artery stenosis. Stroke. 2003;34(11):2767- 73.

Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, et al. The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke. 1999;30(9):1751-8.

Domenig C, Hamdan AD, Belfield AK, Campbell DR, Skillman JJ, LoGerfo FW, et al. Recurrent stenosis and contralateral occlusion: high-risk situations in carotid endarterectomy? Ann Vasc Surg. 2003;17(6):622-8.

Fitzpatrick CM, Chiou AC, DeCaprio JD, Kashyap VS. Carotid revascularization in the presence of contralateral carotid artery occlusion is safe and durable. Mil Med. 2005;170(12):1069-74.

Bagaev E, Pichlmaier AM, Bisdas T, Wilhelmi MH, Haverich A, Teebken OE. Contralateral internal carotid artery occlusion impairs early but not 30-day stroke rate following carotid endarterectomy. Angiology. 2010;61(7):705-10.

Goodney PP, Wallaert JB, Scali ST, Stone DH, Patel V, Shaw P, et al. Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion. J Vasc Surg. 2012;55(1):61-71 e1.

Ricotta JJ, 2nd, Upchurch GR, Jr., Landis GS, Kenwood CT, Siami FS, Tsilimparis N, et al. The influence of contralateral occlusion on results of carotid interventions from the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014;60(4):958-64; discussion 64-5.

Pothof AB, Soden PA, Fokkema M, Zettervall SL, Deery SE, Bodewes TCF, et al. The impact of contralateral carotid artery stenosis on outcomes after carotid endarterectomy. J Vasc Surg. 2017;66(6):1727-34 e2.

Clouse WD, Boitano LT, Ergul EA, Kashyap VS, Malas MB, Goodney PP, et al. Contralateral Occlusion and Concomitant Procedures Drive Risk of Non- ipsilateral Stroke After Carotid Endarterectomy. Eur J Vasc Endovasc Surg. 2019;57(5):619-25.

Grego F, Antonello M, Lepidi S, Zaramella M, Galzignan E, Menegolo M, et al. Is contralateral carotid artery occlusion a risk factor for carotid endarterectomy? Ann Vasc Surg. 2005;19(6):882-9.

Ballotta E, Da Giau G, Baracchini C. Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study. Langenbecks Arch Surg. 2002;387(5-6):216-21.

Taboada CR, Duran Marino JL, Garcia Colodro JM, Pena Holguin J, Martinez Gallego EL. Clinical Outcomes after Carotid Endarterectomy in Patients with Contralateral Carotid Occlusion. Ann Vasc Surg. 2016;32:83-7.

Kong J, Li J, Ye Z, Fan X, Wen J, Zhang J, et al. Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion. Ann Thorac Cardiovasc Surg. 2017;23(5):227-32.

Karmeli R, Lubezky N, Halak M, Loberman Z, Weller B, Fajer S. Carotid endarterectomy in awake patients with contralateral carotid artery occlusion. Cardiovasc Surg. 2001;9(4):334-8.

Rockman CB, Su W, Lamparello PJ, Adelman MA, Jacobowitz GR, Gagne PJ, et al. A reassessment of carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic patients. J Vasc Surg. 2002;36(4):668-73.

Dalainas I, Nano G, Bianchi P, Casana R, Malacrida G, Tealdi DG. Carotid endarterectomy in patients with contralateral carotid artery occlusion. Ann Vasc Surg. 2007;21(1):16-22.

Capoccia L, Sbarigia E, Rizzo AR, Pranteda C, Menna D, Sirignano P, et al. Contralateral occlusion increases the risk of neurological complications associated with carotid endarterectomy. Int J Vasc Med. 2015;2015:942146.

Cinar B, Goksel OS, Karatepe C, Kut S, Aydogan H, Filizcan U, et al. Is routine intravascular shunting necessary for carotid endarterectomy in patients with contralateral occlusion? A review of 5-year experience of carotid endarterectomy with local anaesthesia. Eur J Vasc Endovasc Surg. 2004;28(5):494-9.

Kretz B, Abello N, Astruc K, Terriat B, Favier C, Bouchot O, et al. Influence of the contralateral carotid artery on carotid surgery outcome. Ann Vasc Surg. 2012;26(6):766-74.

Maatz W, Kohler J, Botsios S, John V, Walterbusch G. Risk of stroke for carotid endarterectomy patients with contralateral carotid occlusion. Ann Vasc Surg. 2008;22(1):45-51.

Faggioli G, Pini R, Mauro R, Freyrie A, Gargiulo M, Stella A. Contralateral carotid occlusion in endovascular and surgical carotid revascularization: a single centre experience with literature review and meta-analysis. Eur J Vasc Endovasc Surg. 2013;46(1):10-20.

Turley RS, Freischlag K, Truong T, Benrashid E, Kuchibahtla M, Shortell CK, et al. Carotid stenting and endarterectomy and contralateral carotid occlusion. J Vasc Surg. 2019;70(3):824-31.

Baker WH, Howard VJ, Howard G, Toole JF. Effect of contralateral occlusion on long-term efficacy of endarterectomy in the asymptomatic carotid atherosclerosis study (ACAS). ACAS Investigators. Stroke. 2000;31(10):2330-4.

Gasecki AP, Eliasziw M, Ferguson GG, Hachinski V, Barnett HJ. Long- term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. J Neurosurg. 1995;83(5):778-82.

Montisci R, Sanfilippo R, Bura R, Branca C, Piga M, Saba L. Status of the circle of Willis and intolerance to carotid cross-clamping during carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013;45(2):107-12.

Banga PV, Varga A, Csobay-Novak C, Kolossvary M, Szanto E, Oderich GS, et al. Incomplete circle of Willis is associated with a higher incidence of neurologic events during carotid eversion endarterectomy without shunting. J Vasc Surg. 2018;68(6):1764-71.

Pennekamp CW, van Laar PJ, Hendrikse J, den Ruijter HM, Bots ML, van der Worp HB, et al. Incompleteness of the circle of Willis is related to EEG- based shunting during carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013;46(6):631-7.

Lareyre F, Raffort J, Weill C, Marse C, Suissa L, Chikande J, et al. Patterns of Acute Ischemic Strokes After Carotid Endarterectomy and Therapeutic Implications. Vasc Endovascular Surg. 2017;51(7):485-90.

Chongruksut W, Vaniyapong T, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev. 2014(6):CD000190.

Group GTC, Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008;372(9656):2132-42.

Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493-501.

Mehta RH, Zahn R, Hochadel M, Mudra H, Ischinger T, Hauptmann KE, et al. Effectiveness and safety of carotid artery stenting for significant carotid stenosis in patients with contralateral occlusion (from the German ALKK- CAS Registry experience). Am J Cardiol. 2009;104(5):725-31.

Goldstein MR. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;274(19):1505-6.

Downloads

Published

2022-07-01

How to Cite

1.
Duarte-Gamas L, Pereira-Neves A, Jácome F, Domingues-Monteiro D, Rocha-Neves JP. The Effect of Contralateral Carotid Occlusion in Patients Undergoing Carotid Artery Endarterectomy. Angiol Cir Vasc [Internet]. 2022 Jul. 1 [cited 2024 Mar. 28];18(1):30-5. Available from: https://acvjournal.com/index.php/acv/article/view/419

Issue

Section

Review Article